Chirurgia (Bucur). 2022 Jun;117(4):463-471. doi: 10.21614/chirurgia.2756.
Acute pancreatitis (AP) is a severe disease that usually involves hospitalization and a customized therapy. To date, remarkable progress has been made in establishing the etiology, diagnosis and therapy of this condition. For example, it is well documented that the AP course consists of two distinct pathophysiological phases. The first phase lasts about 1-2 weeks, involving only local inflammatory changes and possibly a transient SIRS syndrome, which require conservative therapy. The second phase is represented either by disease remission in patients with mild forms of AP, or by the persistence of SIRS syndrome and the occurrence of local complications in patients with moderate forms. Local complications therefore often occur in the second phase, when therapy must be customized according to the complications of the pancreatic area, as well as to provide adequate systemic support. Methods/ Severe forms are less common and generally associate MSOF, which can develop at any time in the evolution of AP. MSOF worsens preexisting SIRS syndrome and local complications, making treatment more difficult and significantly increasing morbidity and mortality. This study presents the evolution of a group of patients with acalculous AP, who did not present in the first phase any systemic determinant of SIRS syndrome. Consequently, our initial prognosis was favorable, but the evolution of some patients was unexpectedly severe. Such surprising cases in terms of the evolution may suggest that increased caution is required in all AP patients, even if preliminary data suggest a mild form of the disease. Additional studies are necessary in the near future on this topic, both to improve therapy and to establish a better prognostic score by using new diagnostic tools.
急性胰腺炎（AP）是一种严重的疾病，通常需要住院治疗和个性化治疗。迄今为止，在确定该病的病因、诊断和治疗方面已经取得了显著进展。例如，有充分的证据表明，AP 病程包括两个截然不同的病理生理阶段。第一阶段持续约 1-2 周，仅涉及局部炎症变化，可能伴有短暂的全身炎症反应综合征（SIRS），需要保守治疗。第二阶段代表轻度 AP 患者的疾病缓解，或中度 AP 患者的 SIRS 综合征持续存在和局部并发症发生。因此，局部并发症通常发生在第二阶段，此时必须根据胰腺区域的并发症以及提供充足的全身支持来定制治疗方案。方法/严重形式较少见，通常与多器官功能不全综合征（MSOF）相关，MSOF 可在 AP 演变的任何时间发生。MSOF 会加重原有 SIRS 综合征和局部并发症，使治疗更加困难，并显著增加发病率和死亡率。本研究介绍了一组无结石性 AP 患者的演变情况，他们在第一阶段没有出现任何 SIRS 综合征的系统性决定因素。因此，我们最初的预后是有利的，但一些患者的病情出人意料地严重。在这种情况下，我们需要对所有 AP 患者保持警惕，即使初步数据提示疾病为轻度。在不久的将来，我们需要对这个话题进行更多的研究，以改善治疗效果，并利用新的诊断工具建立更好的预后评分。
